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Bipolar disorder
| r DiseasesDB = 7812 | MedlinePlus = 001528 | eMedicineSubj = med | eMedicineTopic = 229 | *Evidence Based Treatment| }} Bipolar disorder, is a psychiatric diagnosis defined in the DSM-IV-TR. It is a disorder characterized by periods of extreme, often inappropriate, and sometimes unpredictable mood states. In the past this disorder was called manic-depression. The term "manic-depression" was coined to describe the high emotional states of mania and depression that were experienced. Bipolar individuals generally experience mania, hypomania or mixed states alternating with clinical depression and euthymic or normal range of mood over varied periods of time. There are many variations of this disorder. A person with bipolar disorder generally tends to experience more extreme states of mood than other people. Moods can change quickly (many times a day) or last for months. Bipolar individuals tend to have very 'black and white' thinking, where everything in life is either a positive aspect or a negative. Mood patterns of this nature are associated with distress and disruption, and a relatively high risk of suicide. Bipolar disorder is also associated with a variety of cognitive deficits, in particular, difficulty in organizing and planning. The disorder may also skew the ability to judge others' emotion, and alter sense of awareness. Bipolar individuals can be overly observant and analytical of their environment, and in some cases paranoid of others. http://bipolar.about.com/cs/faqs/f/faq_paranoia.htm Bipolar disorder is usually treated with medications that help to stabilize mood, and/or therapy and counselling. Some studies have suggested that while bipolar disorder alters emotion, there may be a correlation between creativity and bipolar disorder, although it is unclear what the relationship is between the two. Santosa et al. Enhanced creativity in bipolar disorder patients: A controlled study. J Affect Disord. 2006 Nov 23; PMID 17126406. Rihmer et al. Creativity and mental illness. Psychiatr Hung. 2006;21(4):288-94. PMID 17170470. Nowakowska et al. Temperamental commonalities and differences in euthymic mood disorder patients, creative controls, and healthy controls. J Affect Disord. 2005 Mar;85(1-2):207-15. PMID 15780691. Aspects of bipolar disorder Bipolar disorder is commonly categorised as either Bipolar Type I, where an individual experiences full-blown mania, or Bipolar Type II, in which the hypomanic "highs" do not go to the extremes of mania. The latter is much more difficult to diagnose, since the hypomanic episodes may simply appear as a period of successful high productivity and is reported less frequently than a distressing depression. Psychosis can occur, particularly in manic periods. There are also 'rapid cycling' subtypes. Because there is so much variation in the severity and nature of mood-related problems, the concept of a bipolar spectrum is often employed, which includes cyclothymia. There is no consensus as to how many 'types' of bipolar disorder exist (Akiskal and Benazzi, 2006). Many people with bipolar disorder experience severe anxiety and are very irritable (to the point of rage) when in a manic state, while others are euphoric and grandiose. The Depressive Phase Signs and symptoms of the depressive phase of bipolar disorder include (but in no way are limited to): persistent feelings of sadness, anxiety, guilt, anger, isolation and/or hopelessness, disturbances in sleep and appetite, fatigue and loss of interest in usually enjoyed activities, problems concentrating, loneliness, self-loathing, apathy or indifference, depersonalization, loss of interest in sexual activity, shyness or social anxiety, irritability, chronic pain (with or without a known cause), lack of motivation, and morbid/suicidal ideation]. Mania People having a manic episode of mood can be elated, euphoric, irritated and/or suspicious. There will be an increase in physical and mental rate and quality. Increased energy and over-activity is common; speech can become racing. The need for sleep is reduced. Attention span is low and easily distracted. Unrealistic, grandiose or over optimistic ideas may be voiced or attempted. Social skills are impaired, and impractical ideas may lead to financial and relationship indiscretions. Hypomania Hypomania is generally a less destructive state than mania, and people in the hypomanic phase generally experience less of the symptoms of mania than those in a full-blown manic episode. The duration is usually also shorter than in mania. This is often a very 'artistic' state of the disorder, where there is a flight of ideas, extremely clever thinking, and an increase in energy. Mixed state In the context of bipolar disorder, a mixed state is a condition during which symptoms of mania and clinical depression occur simultaneously (for example, agitation, anxiety, aggressiveness or belligerence, confusion, fatigue, impulsiveness, insomnia, irritability, morbid and/or suicidal ideation, panic, paranoia, persecutory delusions, pressured speech, racing thoughts, restlessness, and rage). Mixed episodes can be the most volatile of the bipolar states, as moods can easily and quickly be triggered or shifted. Suicide attempts, substance abuse, and self-mutilation may occur during this state. Rapid cycling Rapid cycling, defined as having four or more episodes per year, is found in a significant fraction of patients with bipolar disorder. It has been associated with greater disability or a worse prognosis, due to the confusing changeability and difficulty in establishing a stable state. Rapid cycling can be induced or made worse by antidepressants. Cognition Numerous studies show that bipolar disorder involves certain cognitive deficits or impairments, even in states of remission. Deborah Yurgelun-Todd of McLean Hospital in Belmont, Massachusetts has argued these deficits should be included as a core feature of bipolar disorder. According to McIntyre et al. (2006), "study results now press the point that neurocognitive deficits are a primary feature of BD; they are highly prevalent and persist in the absence of overt symptomatology. Although disparate neurocognitive abnormalities have been reported, disturbances in attention, visual memory, and executive function are most consistently reported." . Creativity A number of recent studies have observed a correlation between creativity and bipolar disorder, although it is unclear in which direction the cause lies, or whether both conditions are caused by some third, unknown, factor. It has been hypothesized that temperament may be one such factor. Children Children with bipolar disorder may not meet the DSM-IV definition. In pediatric cases, the cycling can occur very quickly (see section above on rapid cycling). name=Kranowitz, C.S. & Post, R., (1996)>Kranowitz, C.S. & Post, R., (1996). Ultra-rapid and ultradian cycling in bipolar affective illness. British Journal of Psychiatry, 168, 314-323. Children with bipolar disorder tend to have rapid-cycling or mixed-cycling Demitri F. Papolos, D.F., & Papolos, J., (2002), The Bipolar Child: The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder, NY: Dell. Rapid cycling occurs when the cycles between depression and mania occur quickly, sometimes within the same day or the same hour. When the symptoms of both mania and depression occur simultaneously, mixed cycling occurs. Often other psychiatric conditions are diagnosed in bipolar children. These other diagnoses may be concurrent problems, or they may be misdiagnosed as bipolar disorder. Depression, ADHD, ODD, schizophrenia, and Tourette syndrome are common comorbid conditions. Furthermore some children with histories of abuse or neglect may have Bipolar I Disorder. There is a high comorbidity between Reactive attachment disorder and Bipolar I Disorder with about 50% of children in the Child Welfare System who have Reactive Attachment Disorder also have Bipolar I Disorder Alston, J., (2000), Correlation between Childhood Biploar I Disorder and Reactive Attachment Disorder, Disinhibited Type. In Attachment Interventions, Edited ty T. Levy, 2000, Academic Press. Misdiagnosis can lead to incorrect medication. On September, 2007, experts (from New York, Maryland and Madrid) found that the number of American children and adolescents treated for bipolar disorder increased 40-fold from 1994 to 2003, and it was increasing ever since. However, the increase was due to the fact that doctors more aggressively applied the diagnosis to children, and not that the incidence of the disorder had increased. The study calculated the number of visits which increased, from 20,000 in 1994 to 800,000 in 2003, or 1% of the population under age 20. New York Times, Bipolar Illness Soars as a Diagnosis for the Young History Biological approaches Theoretical approaches Developmental aspect Epidemiology Risk factors Causes Comorbidity Assessment Treatment User information Carer information Suicide risk People with a diagnosis of bipolar disorder are at higher risk of suicide. It is estimated that 10 to 15 per cent of people admitted to hospital with the diagnosis will eventually die by suicide. {cn} Although many people with bipolar disorder who attempt suicide never actually complete it, the annual average suicide rate in males and females with diagnosed bipolar disorder (0.4%) is 10 to more than 20 times that in the general population Individuals with bipolar disorder tend to become suicidal, especially during mixed states such as dysphoric mania and agitated depression. Persons suffering from Bipolar II have high rates of suicide compared to persons suffering from other mental illnesses, including Major Depression. Major Depressive episodes are part of the Bipolar II experience, and some have speculated that sufferers of this disorder spend much of their life in the depressive phase of the illness. Divorce rate According to Psychology Today , the divorce rate for couples where at least one spouse is bipolar is 90%. For comparison purposes, the general divorce rate is commonly held to be about half as much (around 50%), implying that this illness causes substantial additional burdens on married life. Diagnosis Diagnostic criteria Flux is the fundamental nature of bipolar disorder. Both within and between individuals with the illness, energy, mood, thought, sleep, and activity are among the continually changing biological markers of the disorder. The diagnostic subtypes of bipolar disorder are thus static descriptions—snapshots, perhaps—of an illness in continual change, with a great diversity of symptoms and varying degrees of severity. Individuals may stay in one subtype, or change into another, over the course of their illness. The DSM V, to be published in 2011, will likely include further and more accurate sub-typing (Akiskal and Ghaemi, 2006). There are currently four types of bipolar illness. The ''Diagnostic and Statistical Manual of Mental Disorders-IV-TR'' (DSM-IV-TR) details four categories of bipolar disorder, Bipolar I, Bipolar II, Cyclothymia, and Bipolar Disorder NOS (Not Otherwise Specified). For a diagnosis of Bipolar I disorder according to the DSM-IV-TR, there requires one or more manic or mixed episodes. A depressive episode is not required for the diagnosis of Bipolar I disorder but it frequently occurs. Bipolar II, which occurs more frequently is usually characterized by at least one episode of hypomania and at least one depression. A diagnosis of Cyclothymic Disorder requires the presence of numerous hypomanic episodes, intermingled with depressive episodes that do not meet full criteria for major depressive episodes. The main idea here is that there is a low-grade cycling of mood which appears to the observer as a personality trait, but interferes with functioning. If an individual clearly seems to be suffering from some type of bipolar disorder but does not meet the criteria for one of the subtypes above, he or she receives a diagnosis of Bipolar Disorder NOS (Not Otherwise Specified). Although a patient will most likely be depressed when they first seek help, it is very important to find out from the patient or the patient's family or friends if a manic or hypomaniac episode has ever been present, using careful questioning. This will prevent misdiagnosis of Depressive Disorder and avoids the use of an antidepressant which may trigger a "switch" to hypomania or mania or induce rapid cycling. Recent screening tools such as the Hypomanic Check List Questionnaire (HCL-32) have been developed to assist the quite often difficult detection of Bipolar II disorders. Research findings The MRC eMonitoring Project, another research study based at the Institute of Psychiatry and Newcastle Universities, is conducting novel research on electronic monitoring methodologies (electronic mood diaries and actigraphy) for tracking bipolar symptom fluctuations in Bipolar individuals who are interested in self-managing their condition. Medical imaging Researchers are using advanced brain imaging techniques to examine brain function and structure in people with bipolar disorder, particularly using the functional MRI and positron emission tomography. An important area of neuroimaging research focuses on identifying and characterizing networks of interconnected nerve cells in the brain, interactions among which form the basis for normal and abnormal behaviors. Researchers hypothesize that abnormalities in the structure and/or function of certain brain circuits could underlie bipolar and other mood disorders, and studies have found anatomical differences in areas such as the prefrontal cortexPrefrontal Cortex in Bipolar Disorder Neurotransmitter.net. and hippocampus. Better understanding of the neural circuits involved in regulating mood states, and genetic factors such as the cadherin gene FAT linked to bipolar disorder, may influence the development of new and better treatments, and may ultimately aid in early diagnosis and even a cure New treatments In late 2003, researchers at McLean Hospital found tentative evidence of improvements in mood during echo-planar magnetic resonance spectroscopic imaging (EP-MRSI), and attempts are being made to develop this into a form which can be evaluated as a possible treatment.LFMS: Low Field Magnetic Stimulation: Original EP-MRSI Study in Volunteers with Bipolar Disorder McLean Hospital Neuroimaging Center. | url = http://ajp.psychiatryonline.org/cgi/content/full/161/1/93}} NIMH has initiated a large-scale study at 20 sites across the United States to determine the most effective treatment strategies for people with bipolar disorder. This study, the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), will follow patients and document their treatment outcome for 5-8 years. For more information, visit the Clinical Trials page of the NIMH Web site. Transcranial magnetic stimulation is another fairly new technique being studied. Pharmaceutical research is extensive and ongoing, as seen at clinicaltrials.gov. Mortality "Mortality studies have documented an increase in all-cause mortality in patients with BD. A newly established and rapidly growing database indicates that mortality due to chronic medical disorders (eg, cardiovascular disease) is the single largest cause of premature and excess deaths in BD. The standardized mortality ratio from suicide in BD is estimated to be approximately 18 to 25, further emphasizing the lethality of the disorder.". . See also * Affective disorders * Affective psychosis * Associated features of bipolar disorder * Bipolar disorders research * Bipolar spectrum * Creativity and bipolar disorder * Cyclothymia * Cyclothymic personality * Emotion * Emotional dysregulation * International Society for Bipolar Disorders * Mood (psychology) * Oppositional Defiance Disorder * Seasonal affective disorder References *BPS (2010). Understanding Bipolar Disorder:Why some people experience extreme mood states and what can help. full text *Goodwin FK, Jamison KR. Manic-depressive illness. New York: Oxford University Press, 1990. *Geller B, Luby J. Child and adolescent bipolar disorder: a review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 1997; 36(9): 1168-76. *Hyman SE, Rudorfer MV. Depressive and bipolar mood disorders. In: Dale DC, Federman DD, eds. Scientific American®; Medicine. Vol. 3. New York: Healtheon/WebMD Corp., 2000; Sect. 13, Subsect. II, p. 1. *Hyman SE. Introduction to the complex genetics of mental disorders. Biological Psychiatry, 1999; 45(5): 518-21. *Huxley NA, Parikh SV, Baldessarini RJ. Effectiveness of psychosocial treatments in bipolar disorder: state of the evidence. Harvard Review of Psychiatry, 2000; 8(3): 126-40. *Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27. *Mueser KT, Goodman LB, Trumbetta SL, Rosenberg SD, Osher FC, Vidaver R, Auciello P, Foy DW. Trauma and posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology, 1998; 66(3): 493-9. *NIMH Genetics Workgroup. Genetics and mental disorders. NIH Publication No. 98-4268. Rockville, MD: National Institute of Mental Health, 1998. *Sachs GS, Thase ME. Bipolar disorder therapeutics: maintenance treatment. Biological Psychiatry, 2000; 48(6): 573-81. *Soares JC, Mann JJ. The anatomy of mood disorders—review of structural neuroimaging studies. Biological Psychiatry, 1997; 41(1): 86-106. *Soares JC, Mann JJ. The functional neuroanatomy of mood disorders. Journal of Psychiatric Research, 1997; 31(4): 393-432. *Stoll AL, Severus WE, Freeman MP, Rueter S, Zboyan HA, Diamond E, Cress KK, Marangell LB. Omega 3 fatty acids in bipolar disorder: a preliminary double-blind, placebo-controlled trial. Archives of General Psychiatry, 1999; 56(5): 407-12. Further reading Contemporary first-person accounts on this subject include * Jamison, Kay Redfield. 1995. An Unquiet Mind: A Memoir of Moods and Madness. New York: Knopf. ISBN 0-330-34651-2. * Simon, Lizzie. 2002. Detour: My Bipolar Road Trip in 4-D. New York: Simon and Schuster. ISBN 0-7434-4659-3. * Behrman, Andy. 2002. Electroboy: A Memoir of Mania. New York: Random House, 2002. ISBN 0-375-50358-7. * McCarter, Melissa Miles. 2009. Insanity: A Love Story. https://www.createspace.com/3400895 For a practical guide to living with bipolar disorder from the perspective of the sufferer, see * Kelly, Madeleine [http://www.twotreesmedia.com/beatbipolar.htm Bipolar and the Art of Roller-coaster Riding]. Strathbogie: Two Trees Media 2005 ISBN 0-646-44939-7 For a critique of genetic explanations of bipolar disorder, see *Joseph, J. 2006. [http://www.jayjoseph.net/MissingGeneChapters.html The Missing Gene: Psychiatry, Heredity, and the Fruitless Search for Genes]. New York: Algora. For readings regarding bipolar disorder in children, see: * Raeburn, Paul. 2004. Acquainted with the Night: A Parent's Quest to Understand Depression and Bipolar Disorder in His Children. * Earley, Pete. Crazy. 2006. New York: G. P. Putnam's Sons. ISBN 0-399-15313-6. A father's account of his son's bipolar disorder. * About Pediatric Bipolar Disorder: www.bpkids.org/site/PageServer?pagename=lrn_about * The Child and Adolescent Bipolar Foundation: www.bpkids.org * Time Magazine checklist for childhood/adolescent bipolarity: www.time.com/time/covers/1101020819/worksheet/ * A Model IEP for a bipolar child's medication that works correctly: http://www.bipolarchild.com/iep.html Classic works on this subject include * Kraepelin, Emil. 1921. Manic-depressive Insanity and Paranoia ISBN 0-405-07441-7 (English translation of the original German from the earlier eighth edition of Kraepelin's textbook - now outdated, but a work of major historical importance). * Manic-Depressive Illness by Frederick K. Goodwin and Kay Redfield Jamison. ISBN 0-19-503934-3 (The standard, very lengthy, medical reference on bipolar disorder.) * Touched With Fire: Manic-Depressive Illness and the Artistic Temperament by Kay Redfield Jamison (The Free Press: Macmillian, Inc., New York, 1993) 1996 reprint: ISBN 0-684-83183-X * Mind Over Mood: Cognitive Treatment Therapy Manual for Clients by Christine Padesky, Dennis Greenberger. ISBN 0-89862-128-3 Other books *Campell, J.D. (1953). Manic-depressive disease. Clinical and psychiatric significance. Philadelphia: Lippincott Company. *Jones, S.H. & Bentall, R.P. (2006). The psychology of bipolar disorder. Oxford: Oxford University Press. *Lam, D., Jones, S.H., Haywood, P., Bright, J.A. (1999).In J.M.G. Williams (Ed.) Cognitive therapy for bipolar disorder: A therapist’s guide to concepts, methods and practice. The Wiley Series in Clinical Psychology. Chichester: John Wiley & Sons. Other papers *Akiskal, H.S., Djenderedjian, A.H., Rosenthal, R.H., & Khani, M.K. (1977). yclothymic disorder: Validating criteria for inclusion in the bipolar affective group. American Journal of Psychiatry, 134(11), 1227–1233. *Akiskal, H.S., Bourgeois, M.L., Angst, J., Post, R., Moller, H. & Hirschfield, R. (2000). Reevaluating the prevalence of and diagnostic composition within the broad clinical spectrum of bipolar disorders. Journal of Affective Disorders, 59(Suppl 1), S5–S30. *Alloy, L.B., Reilly-Harrington, N., Fresco, D.M., Whitehouse, W.G. & Zechmeister, J.S. (1999). Cognitive styles and life events in subsyndromal unipolar and bipolar disorders: Stability and prospective prediction of depressive and hypomanic moodswings. Journal of Cognitive Psychotherapy, 13(1), 21–40. *Ambelas, A. (1987). Life events and mania. A special relationship? British Journal of Psychiatry, 150, 235–40. *Andreasen, N.C. (1987). Creativity and mental illness: Prevalence rates in writers and their first-degree relatives. American Journal of Psychiatry, 144(10), 1288–92. *Angst, J. (1998). The emerging epidemiology of hypomania and bipolar II disorder. Journal of Affective Disorders, 50, 143–151. *Angst, J., Gamma, A., Benazzi, F., et al. (2003). Toward a re-definition of subthreshold bipolarity: Epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania. Journal of Affective Disorders, 73, 133–146. *Ball, J.R., Mitchell, P.B., Corry, J.C., Skillecorn, A., Smith, M. & Malhi, G.S. (2006). A randomized controlled trial of cognitive therapy for bipolar disorder: Focus on longterm change. Journal of Clinical Psychiatry, 67(2), 277–86. *Barbato, N. & Hafner, R.J. (1998). Comorbidity of bipolar and personality disorder. Australian and New Zealand Journal of Psychiatry, 32(2), 276–80. *Bauer, M., McBride, L., Chase, C., Sachs, G. & Shea, N. (1998). Manual-based group psychotherapy for bipolar disorder: A feasibility study. Journal of Clinical Psychiatry, 59(9), 449–455. *Bauer, M.S., McBride, L., Williford, W.O., Glick, H., Kinosian, B., Altshuler, L., Beresford,T., Kilbourne, A.M. & Sajatovic, M. (2006) Collaborative care for bipolar disorder:part I. Intervention and implementation in a randomized effectiveness trial. Psychiatric Services, 57, 927–36. *Bentall, R.P., Kinderman, P. & Manson, K. (2005). Self-discrepancies in bipolar disorder:Comparison of manic, depressed, remitted and normal participants. British Journal of Clinical Psychology, 44(4), 457–73. *Berrettini, W. (2004). Bipolar disorder and schizophrenia: Convergent molecular data. Neuromolecular Medicine, 5, 109–117. *Blackwood, D.H.R., Pickard, B.J., Thomson, P.A., Evans, K.L., Porteous, D.J. & Muir, W.J.(2007). Are some genetic risk factors common to schizophrenia, bipolar disorder and depression? Evidence from DISC1, GRIK4 and NRG1. Neurotoxicity Research, 11(1), 73–83. *Boylan K.R., Bieling P.J., Marriott M., Begin H., Young L.T., MacQueen, G.M. (2004). Impact of comorbid anxiety disorders on outcome in a cohort of patients with bipolar disorder. Journal of Clinical Psychiatry, 65(8), 1106–1113. *Carta, M.G. & Angst, J. (2005). Epidemiological and clinical aspects of bipolar disorders:Controversies or a common need to redefine the aims and methodological aspects of surveys. Clinical Practice and Epidemiology in Mental Health, 1(4). *Cassidy, F., Ahearn, E.P. & Carroll, B.J. (2001). Substance abuse in bipolar disorder. Bipolar Disorder, 3(4), 181–8. *Chen, Y.R., Swann, A.C. & Johnson, B.A. (1998). Stability of diagnosis in bipolar disorder.Journal of Nervous and Mental Disease, 186, 17–23. *Clark, L., Iversen, S.D. & Goodwin, G.M. (2002). Sustained attention deficit in bipolar disorder. British Journal of Psychiatry, 180, 313–319. *Clarkin, J.F., Carpenter, D., Hull, J., Wilner, P. & Glick, I. (1998). Effects of psychoeducational intervention for married patients with bipolar disorder and their spouses. Psychiatric Services, 49(4), 531–3. *Colom, F., Vieta, E., Sanchez-Moreno, J., Palomino-Otiniano, R., Reinares, M., Goikolea,J.M., Benabarre, A. & Martinez-Aran, A. (2009). Group psychoeducation for stabilized bipolar disorders: Five-year outcome of a randomised clinical trial. British Journal of Psychiatry, 194(3), 260–5. *Coryell, W., Endicott, J., Keller, M., Andreasen, N., Grove, W., Hirschfeld, R.M.A. et al. (1989). Bipolar affective disorder and high achievement: A familial association. American Journal of Psychiatry, 146, 983–988. *Coryell, W., Turvey, C., Endicott, J., Leon, A.C., Mueller, M., Solomon, D., Keller, M. (1998). Bipolar I affective disorder: Predictors of outcome after 15 years. Journal of Affective Disorders, 50(2), 109–116. *DelBello, M.P., Adler, C.M. & Strakowski, S.M. (2006). The neurophysiology of childhood and adolescent bipolar disorder. CNS Spectrum, 11(4), 298–311. *Depue, R.A., Slater, J.F., Wolfstetter-Kausch, H., Klein, D., Goplerud, E. & Farr, D. (1981).A behavioral paradigm for identifying persons at risk for bipolar depressive disorder:A conceptual framework and five validation studies. Journal of Abnormal Psychology,90(5), 381–437 *Dienes, K.A., Hammen, C., Henry, R.M., Cohen, A.N. & Daley, S.E. (2006). The stress sensitization hypothesis: Understanding the course of bipolar disorder. Journal of Affective Disorders, 95, 43–49. *Dore, G. & Romans, S.E. (2001). Impact of bipolar affective disorder on family and partners. Journal of Affective Disorders, 67(1–3), 147–158. *Dubicka, B., Carlson, G.A., Vail, A. & Harrington, R. (2008). Prepubertal mania: Diagnostic differences between US and UK clinicians. European Child and Adolescent Psychiatry,17(3), 153–161. *Ellicott, A., Hammen, C., Gitlin, M., Brown, G. & Jamison, K. (1990). Life events and the course of bipolar disorder. American Journal of Psychiatry, 147(9), 1194–8. *Evans, D.L. (2000). Bipolar disorder: Diagnostic challenges and treatment considerations. Journal of Clinical Psychiatry, 61, 26–31. *Frank, E., Kupfer, D.J., Thase, M.E., Mallinger, A.G., Swartz, H.A., Fagiolini, A.M., Grochocinski, V., Houck, P., Scott, J., Thompson, W. & Monk, T. (2005). Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Archives of General Psychiatry, 62(9), 996–1004. *Freeman, M.P., Freeman, S.A. & McElroy, S.L. (2002). The comorbidity of bipolar and anxiety disorders: Prevalence, psychobiology, and treatment issues. Journal of Affective Disorders, 68(1), 1–23. *Furnham, A., Batey, M., Anand, K. & Manfield, J. (2008). Personality, hypomania, intelligence and creativity. Personality and Individual Differences, 44, 1060–1069. *Geddes, J., Burgess, S., Hawton, K., Jamison, K. & Goodwin, G. (2004). Long-term lithium therapy for bipolar disorder: Systematic review and meta-analysis of randomized controlled trials. American Journal of Psychiatry, 161, 217–222. *Gitlin, M.J., Swendsen, J., Heller, T.L. & Hammen, C. (1995). Relapse and impairment in bipolar disorder. American Journal of Psychiatry, 152(11), 1635–40. *Goldberg, J.F., Harrow, M. & Grossman, L.S. (1995). Course and outcome in bipolar affective disorder: A longitudinal follow-up study. American Journal of Psychiatry, 152(3), 379–384. *Goodwin, G.M. (2003). Evidence-based guidelines for treating bipolar disorder: Recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology, 17(2), 149–73; discussion 147. *Hammen, C., Gitlin, M. & Altshuler, L. (2000). Predictors of work adjustments in bipolar I patients: A naturalistic longitudinal follow-up. Journal of Consulting and Clinical Psychology, 68(2), 220–225. *Hammersley, P. et al. (2003). Childhood trauma and hallucinations in bipolar affective disorder: Preliminary investigation. British Journal of Psychiatry, 182, 543–7. *Hawton, K., Sutton, L., Haw, C., Sinclair, J. & Harriss, L. (2005). Suicide and attempted suicide in bipolar disorder: A systematic review of risk factors. Journal of Clinical Psychiatry, 66(6), 693–704. *Hayden, E.P. & Nurnberger, J.I., Jr. (2006). Molecular genetics of bipolar disorder. Genes Brain Behaviour, 5(1), 85–95. *Hilty, D., Brady, K. & Hales, R. (1999). A review of bipolar disorder among adults. Psychiatric Services, 50, 201–213. *Honig, A., Hofman, A., Rozendaal, N. & Dingemans, P. (1997). Psycho-education in bipolar disorder: Effect on expressed emotion. Psychiatry Research, 72(1), 17–22. *Hudson, J.I. et al. (1992). Polysomnographic characteristics of young manic patients. Comparison with unipolar depressed patients and normal control subjects. Archives of General Psychiatry, 49(5), 378–83. *Johnson, L., Lundstrom, O., Aberg-Wistedt, A. & Mathe, A.A. (2003). Social support in bipolar disorder: Its relevance to remission and relapse. Bipolar Disorder, 5(2), 129–37. *Johnson, S.L. (2005). Mania and dysregulation in goal pursuit: A review. Clinical Psychology Review, 25(2), 241–262. *Johnson, S.L. & Miller, I.W. (1997). Negative life events and time to recovery from episodes of bipolar disorder. Journal of Abnormal Psychology, 106(3), 449–457. *Johnson, S.L., Winett, C.A., Meyer, B., Greenhouse, W.J. & Miller, I. (1999). Social support and the course of bipolar disorder. Journal of Abnormal Psychology, 108(4), 558–66. *Johnson, S.L., Winters, R. & Meyer, B. (2006). A polarity-specific model of bipolar disorder. In T.E.J. Joiner, J. Brown & J. Kistner (eds.) The interpersonal, cognitive and social natureof depression. Mahwah, NJ: Lawrence Erlbaum Associates. *Jones, L., Scott, J., Haque, S., Gordon-Smith, K., Heron, J., Forty, E., Hyde, S., Lyon, L., Greening, J., Sham, P., Farmer, A., McGriffin, P., Jones, I. & Craddock, N. (2005). Cognitive style in bipolar disorder. British Journal of Psychiatry, 187, 431–7. *Jones, S.H. (2006). Circadian rhythms and internal attributions in bipolar disorder. In S.H. Jones, S., Mansell, W. & Waller, L. (2006). Appraisal of hypomania-relevant experiences: Development of a questionnaire to assess positive self-dispositional appraisals in bipolar and behavioural high risk samples. Journal of Affective Disorders, 93(1–3), 19–28. *Judd, L.L., Akiskal, H.S., Schettler, P.J, Endicott, J., Maser, J., Solomon, D.A., Leon, A.C., Rice, J.A. & Keller, M.B. (2002). The long-term natural history of the weekly symptomatic status of bipolar I disorder. Archives of General Psychiatry, 59(6), 530–537. *Judd, L.L., Akiskal, H.S., Schettler, P.J., Coryell, W., Endicott, J., Maser, J.D., Solomon, D.A.,Leon, A.C. & Keller, M.B. (2003). A prospective investigation of the natural history ofthe long-term weekly symptomatic status of bipolar II disorder. Archives of General Psychiatry, 60(3), 261–269. *Keck, P.E., Jr., McElroy, S.L., Strakowski, S.M., West, S.A., Sax, K.W., Hawkins, J.M., Bourne, M.L. & Haggard, P. (1998). 12-month outcome of patients with bipolar disorder following hospitalization for a manic or mixed episode. American Journal of Psychiatry, *155(5), 646–652. *Kempton, M.J., Geddes, J.R., Ettinger, U., Williams, S.C.R. & Grasby, P.M. (2008). Metaanalysis, database and meta-regression of 98 structural imaging studies in bipolar disorder. Archives of General Psychiatry, 65(9), 1017–1032. *Kessing, L.V., Hansen, M.G. & Andersen, P.K. (2004). Course of illness in depressive and bipolar disorders. British Journal of Psychiatry, 185(5), 372–377. *Kessler, R.C., Rubinow, D.R., Holmes, C., Abelson, J.M. & Zhao, S. (1997). The epidemiology of DSM-III-R bipolar I disorder in a general population survey. Psychology of Medicine, 27(5), 1079–89. *Lam, D., Bright, J., Jones, S., Hayward, P., Schuck, N. & Chisholm, D. (2000). Cognitive therapy for bipolar illness – a pilot study of relapse prevention. Cognitive Therapy and Research, 24(5), 503–520. *Lam, D.H., Watkins, E.R., Hayward, P., Bright, J., Wright, K., Kerr, N., Parr-Davis, G. & Sham, P. (2003). A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: Outcome of the first year. Archives of General *Psychiatry, 60(2), 145–52. *Levin, F. & Hennessy, G. (2004). Bipolar disorder and substance abuse. Biological Psychiatry,56(10), 738–748. *Lobban, F., Taylor, L., Chandler, C., Tyler, E., Kinderman, P., Kolamunnage-Dona, R., Gamble, C., Peters, S., Pontin, E., Sellwood, W. & Morriss, R. K. (2010). Enhanced relapse prevention for bipolar disorder by community mental health teams: Cluster feasibility randomised trial. British Journal of Psychiatry, 196(1), 59–63. *Mansell, W. & Pedley, R. (2008). The ascent into mania: A review of psychological processes associated with the development of manic symptoms. Clinical Psychology Review, 28(3), 494–520. *Mansell, W., Powell, S., Pedley, R., Thomas, N. & Jones, S.A. (2009). The process of recovery from bipolar I disorder: A qualitative analysis of personal accounts in relation to an integrative cognitive model. *Mansell, W., Rigby, Z., Tai, S. & Lowe, C. (2008). Do current beliefs predict hypomanic symptoms beyond personality style? Factor analysis of the Hypomanic Attitudes and Positive Predictions Inventory (HAPPI) and its association with hypomanic symptoms in a student population. Journal of Clinical Psychology, 64(4), 450–465. *McGuffin, P. et al. (2003). The heritability of bipolar affective disorder and the geneticrelationship to unipolar depression. Archives of General Psychiatry, 60(5), 497-502. *McPherson, H., Herbison, P. & Romans, S. (1993). Life events and relapse in established bipolar affective disorder. British Journal of Psychiatry, 163, 381–385. *Miklowitz, D.J. et al. (2000). Family-focused treatment of bipolar disorder: One-year effects of a psychoeducational program in conjunction with pharmacotherapy. Biological Psychiatry, 48(6), 582–92. *Miklowitz, D.J., George, E.L., Richards, J.A., Simoneau, T.L. & Suddath, R.L. (2003). A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Archives of General Psychiatry, 60(9),904–12. *Miklowitz, D.J., Goldstein, M.J., Nuechterlein, K.H., Snyder, K.S. & Mintz, J. (1988). Family factors and the course of bipolar affective disorder. Archives of General Psychiatry, 45, 225–231. *Miklowitz, D. & Goldstein, M.J. (1990). Behavioral family treatments for patients with bipolar affective disorder. Behavior Modification, 14(4), 457–489. *Moller, H.J. (2003). Bipolar disorder and schizophrenia: Distinct illnesses or a continuum? Journal of Clinical Psychiatry, 64(6), 23–27. *Morriss, R. et al. (2007). Social adjustment based on reported behaviour in bipolar affective disorder. Bipolar Disorder, 9, 53–62. *Mortensen, P.B., Pedersen, C.B., Melbye, M., Mors, O. & Ewald, H. (2003). Individual and familial risk factors for bipolar affective disorders in Denmark. Archives of General Psychiatry, 60, 1209–1215. *Murphy, F.C., Sahakian, B.J., Rubinsztein, J.S., Michael, A., Rogers, R.D., Robbins, T.W. & Paykel, E.S. (1999). Emotional bias and inhibitory control processes in mania and depression. Psychological Medicine, 29(6), 1307–21. *Murphy, F.C., Rubinsztein, J.S., Michael, A., Rogers, R.D., Robbins, T.W., Paykel, E.S. & Sahakian, B.J. (2001). Decision-making cognition in mania and depression. Psychological Medicine, 31(4), 679–93. *Myerson, A. & Boyle, R.D. (1941). The incidence of manic-depressive psychosis in certain socially important families: Preliminary report. American Journal of Psychiatry, 98, 11–21. *NAMI (2008). Understanding bipolar and recovery, Arlington, Il.: National Alliance on Mental Illness. *NICE (2006). Bipolar disorder: The management of bipolar disorder in adults, children and adolescents in primary and secondary care. London: National Institute for Clinical Excellence. *O’Connell, R.A., Mayo, J.A., Flatow, L., Cuthbertson, B., & O’Brien, B.E. (1991). Outcome of bipolar disorder on long-term treatment with lithium. British Journal of Psychiatry, 159, 123–9. *Phelps, J., Angst, J., Katzow, J. & Sadler, J. (2008). Validity and utility of bipolar spectrum models. Bipolar Disorders, 10, 179–193. *Post, R.M., Denicoff, K.D., Leverich, G.S., Altshuler, L.L., Frye, M.A., Suppes, T.M., Rush, A.J., Keck, P.E., Jr., Mcelroy, S.L., Luckenbaugh, D.A., Pollio, C., Kupka, R. & Nolen, W.A. (2003). Morbidity in 258 bipolar outpatients followed for one year with daily prospective ratings on the NIMH life chart method. Journal of Clinical Psychiatry, 64(6), 680–90; quiz 738-9. *Priebe, S., Wildgrube, C. & Muller-Oerlinghausen, B. (1989). Lithium prophylaxis and expressed emotion. British Journal of Psychiatry, 154, 396–399. *Rea, M.M., Tompson, M.C., Miklowitz, D.J., Goldstein, M.J., Hwang, S. & Mintz, J. (2003). Family-focused treatment versus individual treatment for bipolar disorder: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 71(3), 482–92. *Rihmer, Z. & Kiss, K. (2002). Bipolar disorders and suicidal behaviour. Bipolar Disorders, 4(Suppl 1), 21–5. *Romans, S.E. & McPherson, H.M. (1992). The social networks of bipolar affective disorder patients. Journal of Affective Disorders, 25(4) 221–228. *Russell, S.J. & Browne, J.L. (2005). Staying well with bipolar disorder. Austrian and New Zealand Journal of Psychiatry, 39(3), 187–93. *Salloum, I.M. & Thase, M.E. (2000). Impact of substance abuse on the course and treatment of bipolar disorder. Bipolar Disorders, 2(3 Pt 2), 269–80. *Santosa, C.M. et al. (2007). Enhanced creativity in bipolar disorder patients: A controlled study. Journal of Affective Disorders, 100(1–3), p. 31–9. *Scott, J. & Pope, M. (2002). Self-reported adherence to treatment with mood stabilizers, plasma levels, and psychiatric hospitalization. American Journal of Psychiatry, 159(11),1927–9. *Seal, K., Mansell, W. & Mannion, H. (2008). What lies between hypomania and bipolar disorder? A qualitative analysis of twelve non-treatment-seeking people with a history of hypomanic experiences and no history of major depression. Psychology and *Psychotherapy: Theory, Research and Practice, 81(1), 33–53. *Simeonova, D.I., Chang, K.D., Strong, C. & Ketter, T.A. (2005). Creativity in familial bipolar disorder. Journal of Psychiatric Research, 39(6), 623–631. *Solomon, R.L., Keitner, G.I., Miller, I.W., Shea, M.T. & Keller, M.B. (1995). Course of illness and maintenance treatments for patients with bipolar disorders. Journal of Clinical Psychiatry, 56, 5–13. *Strakowski, S.M., Adler, C.M., Holland, S.K., Mills, N. & DelBello, M.P. (2004). A preliminary FMRI study of sustained attention in euthymic, unmedicated bipolar disorder. Neuropsychopharmacology, 29(9), 1734–40. *Stefos, G., Bauwens, F., Staner, L., Pardoen, D. & Mendlewicz, J. (1996). Psychosocial predictors of major affective recurrences in bipolar disorder: A 4-year longitudinal study of patients on prophylactic treatment. Acta Psychiatrica Scandinavica, 93(6), 420–426. *Swann, A.C., Dougherty, D.M., Pazzaglia, P.J., Pham, M. & Moeller, F.G. (2004). Impulsivity:A link between bipolar disorder and substance abuse. Bipolar Disorders, 6(3), 204–12. *Thomas, J., Knowles, R., Tai, S. & Bentall, R.P. (2007). Response styles to depressed mood in bipolar affective disorder. Journal of Affective Disorders, 100, 249–252. *Tohen, M., Zarate, C.A., Jr., Hennen, J., Khalsa, H.M., Strakowski, S.M., Gebre-Medhin, P., Salvatore, P. & Baldessarxini, R.J. (2003). The McLean-Harvard First-Episode Mania *Study: Prediction of recovery and first recurrence. American Journal of Psychiatry, 160(12), 2099–107. *Tsuchiya, K.J., Agerbo, E., Byrne, M. & Mortensen, P. B. (2004). Higher socio-economic status of parents may increase risk for bipolar disorder in the offspring. Psychological Medicine, 34, 787–793. *Udachina, A. & Mansell, W. (2007). Cross-validation of the Mood Disorders Questionnaire, the Internal State Scale, and the Hypomanic Personality Scale. Personality and Individual Differences, 42(8), 1539–1549. *Van der Gucht, E. (2009). Recovery in bipolar disorder: A Q methodological study, p. 131. In Clinical Psychology. Lees: University of Leeds: Leeds. *Wehr, T.A., Sack, D. & Rosenthal, N. (1987). Sleep reduction as a final common pathway to mania. American Journal of Psychiatry, 144, 201–204. *Weinstock, L.M., Keitner, G.I., Ryan, C.E., Solomon, D.A. & Miller, I.W. (2006). Family functioning and mood disorders: A comparison between patients with major depressive disorder and bipolar I disorder. Journal of Consulting and Clinical Psychology, 74(6), 1192–1202. *Weissman, M.W., Bland, R.C., Canino, G.J., Faravelli, C., Greenwald, S., Hwu, H., Joyce, P.R., Karam, E.G., Lee, C., Lellouch, J., Lépine, J., Newman, S.C., Rubio-Stipec, M., Wells, J.E., Wickramaratne, P.J., Wittchen, H. & Yeh, E. (1996). Cross-national *epidemiology of major depression and bipolar disorder. Journal of the American Medical Association, 276(4), 293–9. *Wicki, W. & Angst, J. (1991). The Zurich study. X. Hypomania in a 28–30-year-old cohort. European Archives of Psychiatry and Clinical Neuroscience, 240(6), 339–348. *Wilkins, K. (2004). Bipolar I disorder, social support and work. Health Reports, 15, 21–30. *Williams, J.M.G., Alatiq, Y., Crane, C., Barnhofer, T., Fennell, M.J.V., Duggan, D.S.,Hepburn, S. & Goodwin, G.M. (2008). Mindfulness-based cognitive therapy in bipolar disorder: Preliminary evaluation of immediate effects on between-episodic functioning. Journal of Affective Disorders, 107(1–3), 275–279. *Zimmerman, M., Ruggero, C.J., Chelminski, I. & Young, D. (2008). Is bipolar disorder overdiagnosed? Journal of Clinical Psychiatry, 69(6), 935–940. External links ‘Black and White Thinking’: How to Balance these Cognitive Extremes‘ Category:Affective disorders Category:Bipolar disorder